Tim DeRoche, author of "The Ballad of Huck and Miguel"

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In the New Yorker, Atul Gawande implies that the problem with our health care system is that it isn’t like our K-12 education system:

During the next two centuries, we relied on government to establish a system of compulsory public education, infrastructure for everything from running water to the electric grid, and old-age pensions, along with tax systems to pay for it all. As in other countries, these programs were designed to be universal. For the most part, we didn’t divide families between those who qualified and those who didn’t, between participants and patrons. This inclusiveness is likely a major reason that these policies have garnered such enduring support.

So let’s imagine a world in which the health care system is like our system of public education:

(1) There are local “health care districts” administered by elected politicians.

(2) The HC districts establishes a “local clinic” in each neighborhood. You’re asssigned to your local clinic and required by law to submit to care.

(4) Most of the best doctors choose to work at the clinics in the wealthier, whiter neighborhoods.

(5) Therefore, the clinics in the wealthier, whiter neighborhoods provide better care. They are also full-up with wealthy, white patients. They’re required by law to turn away the poor, brown folks from other neighborhoods who try to gain access to their doctors.

(6) Each clinic is given an “allocation” of doctor positions, so that the ratio of doctors-to-patients is the same across all clinics. Salaries, however, are determined by seniority. The doctors in the upscale clinics make more money, because they typically stick around longer, because the upscale clinics are quite nice places to work. So the upscale clinics actually have larger budgets for doctor salaries, despite the fact that their patient base is healthier. It’s redistribution in reverse!

(7) It’s virtually impossible to fire a doctor. Because they’re doctors! You can’t fire someone who is a doctor. He/she needs to be protected.

To his credit, Gawande identifies the root of all our health-care problems: the moment when the federal government made employer-provided health insurance tax deductible. This whole mess springs from that decision.

But please don’t use K12 education as the model for reforming health care.

The media is applauding John McCain for his “maverick moment” in killing Trumpcare.

I’m no huge fan of John McCain, but I want to note that this is not the first time that McCain has taken a brave stand on health insurance. Back in 2008, when he was running for President, he proposed eliminating the tax deduction for employer-provided health plans.

Economists agree that the tax deduction is a major reason that our health care system is so screwed up:

It’s a huge government give-away, and it disproportionately benefits people who make a lot of money (since their health plans are typically more costly). #welfarefortherich

By linking employment and health insurance, it creates uncertainty and anxiety for anyone who is sick and/or unemployed. (And then the economy gets gummed up with people who are afraid of leaving their jobs because of concerns about health insurance.)

It encourages the over-consumption of health care by putting one more entity between the consumer and the entity that is paying for that health care. (consumer -> employer -> insurance company -> provider group -> health care provider)

I’m unaware of any other Presidential candidate – from either party – who’s been willing to take that brave stand. What did McCain get for his bravery back in 2008? Barack Obama hammered him with fear-mongering ads that called the plan “radical.”

Man pays $2.4 million for celebrity photos. Man agrees to pay an additional $2.4 million to the photographer if his tax avoidance scheme pays off. Man donates photos to a government agency and values gift at $20 million. Another government agency balks at accepting that valuation, perhaps because the market value of the art would seem to be $2.4 million, since that’s what he paid for it.

The New York Times is unsure if this is a tax grab. Maybe. The man is also puzzled. He can’t understand why his actions aren’t “being celebrated.”

We were asked to help facilitate a major gift to the Art Gallery of Nova Scotia that would provide it with a unique collection of art from one of the world’s most praised photographers and that’s exactly what we did.